Provider Demographics
NPI:1861900516
Name:CORNELL PAIN CLINIC LLC
Entity type:Organization
Organization Name:CORNELL PAIN CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-376-9200
Mailing Address - Street 1:15455 NW GREENBRIER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8115
Mailing Address - Country:US
Mailing Address - Phone:503-376-9200
Mailing Address - Fax:503-376-9201
Practice Address - Street 1:15455 NW GREENBRIER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-376-9200
Practice Address - Fax:503-376-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD178982208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500710995Medicaid